Your Rs. 10 lakh health policy exhausts on a Rs. 12 lakh surgery. Without restoration, you're uncovered for 11 months. With it? Insurer automatically refills 100% Sum Insured, some insurers refill up to unlimited times in premium plans for both related and unrelated claims. In this multi-hospitalization era (cancer, accidents), this "backup tank" saves Rs. 20-50 lakh+ per family. But 60% policies limit it to once/year. Here's how to pick the best.
What is Restoration Benefit in Health Insurance?
Restoration Benefit (aka Refill/Reinstatement) automatically replenishes your full Sum Insured (SI) when exhausted by claims within the same policy year. No extra premium, no waiting.
- Triggers: Base Sum Insured + bonuses fully/partially used depending on the insurance (partial often doesn't activate).
- Restores: 100% original Sum Insured (e.g : Rs. 10 lakh → another Rs. 10 lakh).
- For: Related and Unrelated illnesses/accidents (same disease often needs 45-day gap in some insurances).
- Family Floater Magic: Different members trigger separate restorations.
Example: Rs. 5 lakh Sum Insured of a Family Floater. Father's Rs. 5.2 lakh heart surgery exhausts it. Mother's Rs. 3 lakh delivery 6 months later? Restored, Rs. 5 lakh covers full.
How Restoration works?
Activation Flow:
- Claim Filed → Sum Insured exhausts (e.g., Rs. 10 lakh surgery).
- Auto-Trigger → Insurer restores 100% SI immediately.
- New Claims → Use restored amount.
- Repeat? Once/year (standard) or unlimited (premium plans) depending on the insurance plan.
Real Scenario (Family Floater Rs. 10 Lakh SI): Unlimited Restore upon partial exhaustion of Sum Insured.
| Event | Timing | Cost | Coverage Used | Restoration Status |
| Child accident | Jan | Rs. 4 lakh | Rs. 4 lakh used | Rs. 10 lakh restored |
| Parent cancer | Apr | Rs. 12 lakh | Rs. 12 lakh total → Exhaust, Rs. 2 lakh paid by you. | Rs. 10 lakh restored |
| Parent cancer | Oct | Rs. 6 lakh | Rs. 6 lakh from restored | Rs. 10 lakh restored |
Net: Rs. 20 lakhs covered from Rs. 10 lakhs Sum Insured.
Types of Restoration Benefits
| Type | Frequency | Trigger | Best For | Examples |
| Standard (Once/Year) | Once | Full exhaustion | Budget plans | Most Rs. 5-10 lakh SI |
| Unlimited | Any no. of claims | Per exhaustion | Families/chronic | Niva Bupa, Care Supreme+ |
| Partial | 50-80% restore | Partial use | Mid-tier | Some SBI General |
| Rider | Add-on (Rs. 2-5k) | Custom | Existing policies | HDFC Ergo rider (Unlimited Restore) |
IRDAI Norm: Optional benefit; no minimum mandated. Premium plans shine.
When Restoration Saves Big (Real Cases)
Case 1: Cancer Family
- Dad: Rs. 9 lakh chemo (exhausts Rs. 10 lakh SI).
- Mom: Rs. 7 lakh follow-up (restored Rs. 10 lakh covers).
Case 2: Accident Chain
- Car crash (Rs. 6 lakh). Restoration.
- Dengue (Rs. 4 lakh unrelated).
Double dip in 6 months.
Trap: Same illness excluded in some insurances (e.g., 2nd chemo cycle denied).
IRDAI Rules & Claim Process
- Auto-Restoration: No request needed (most plans).
- Docs: Same as hospitalization (discharge linking events).
- Cashless: Network TPA approves restored SI instantly.
- No Carry Forward: Unused restoration expires yearly.
Claim Hack: Always mention "restoration eligible" in pre-auth request.
Checklist: Pick Policies with Killer Restoration
✅ Unlimited Restorations.
✅ 100% Restore (not 50% or Partial Restore).
✅ Applies to Unrelated + Same Family Member (check wording).
❌ Avoid: No restoration or "partial only"
❌ Avoid: Restoration upon Full Exhaustion of Sum Insured
Family Pro: Unlimited + floater = Rs. 50 lakh+ effective from Rs. 10 lakh base.
Conclusion: Restoration = Free Extra Coverage
Standard Rs. 10 lakh SI without restoration = one big claim max. With unlimited restoration? Infinite backups till premiums paid. This turns Health Insurance from "Once-a-year" to "All-year Armour".
Want to know the Right Health Insurance?
or feel free to reach out at hello@honvest.com
Our certified Insurance Advisors can help you with right plan, right coverage, best premium options available
Regards,
Honvest Team.
Frequently asked questions
Here are some common questions about Restoration.
Now most of the insurers offer restoration for same illness as well but some keep a 45-day gap for same Illness, check policy
Yes—each exhaustion triggers (floater plan).
Yes in premium plans, but usually after 30days waiting period in regular plans.
Restoration Benefit in Health Insurance